A Perspective on the Delivery of Renal Denervation Therapy Based on Pre-Clinical Data

Commentary: Renal Nerve Denervation

“…The disappointing results of SYMPLICITY HTN-3 relate to lack of response to the initial RDN, not to a gradual return to higher BPs, as Tellez et al. (1) imply. With a new generation of radiofrequency and ultrasound devices, RDN needs to be a simplified, angiographic event.…”

“…As stated by Tellez et al. (1) , SYMPLICITY HTN-3—the first prospective, sham-controlled, randomized, double-blinded RDN study—failed to meet its primary or secondary efficacy points. Many possible explanations for the disappointing results have been put forth.…”

“…The perspective by Tellez et al. (1) in this issue of JACC: Basic to Translational Science timely summarized the current status of the RDN therapy. One of their hypotheses is that the best surrogate for RDN, that is, the reduction of post-procedure renal norepinephrine (NE) levels, is not sensitive enough to judge success.…”

“…Tellez et al. (1) discuss in detail the effect of “neuromatous regeneration” as an important reason for the failure of treatment despite delivering optimal therapy. As supportive evidence is the publication from Prochnau et al.…”

“…Also, if correct, the assumption by Tellez et al. (1) would require any subsequent RDN to be applied at the precise site where the initial thermal injury occurred. There is no current imaging, biochemical, or functional testing that could identify unequivocally the site of a previous thermal injury, thus making their hypothesis theoretical and impractical.…”